Merchant Application
Please fill out this form and upload files to the best of your ability. If you have any issues please call us!
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Business Contact Information
Contact Name
First Name
Last Name
E-mail
*
example@example.com
Phone Number
*
Fax Number (if needed)
Sales Person Name ( Enter Name if you are the sales person or already have one)
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Business Owner Information
Owner Name
First Name
Last Name
Owner Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Social Security Number
Drives License Photo - Front
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Drives License Photo - Back
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Business Information
Company Name
*
Date Established
-
Month
-
Day
Year
Date
Business EIN/TIN
Phone Number
Please enter a valid phone number.
Email
example@example.com
Company Type
*
Sole Proprietorship
Partnership
Corporation
Other
Company to Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Business Merchant Info
Current Merchant Services Provider
Your anticipated monthly processing volume (can be a rough estimate)
*
Your last 3 months credit card processing statements
*
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Your last 3 months business bank statements
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Please upload a voided check for your business account
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Signature
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